Article
Prophylactic mesh placement for the prevention of parastomal hernias – the PRESTO systematic review and meta-analysis
Search Medline for
Authors
Published: | April 21, 2016 |
---|
Outline
Text
Background: Parastomal hernia (PH) is the most common complication after ostomy formation. Past trials have suggested the use of a prophylactic mesh at the stoma site to reduce the rate of PH. The aim of this systematic review was to summarize the evidence for this method in comparison to the standard procedure without mesh placement.
Materials and methods: A systematic literature search was performed in Pubmed, EMBASE and the Cochrane library without language or date restrictions. Randomized controlled (RCTs) as well as clinical controlled trials (CCTs) were included. Main outcome of interest was PH rate. Statistical analysis included meta-analyses of pooled data; results were described with weighted odds ratios and corresponding 95% confidence intervals.
Results: 396 articles were screened, seven studies (5 RCTs; 2 CCTS) with a total of 288 patients were included. RCTs showed a significant reduction of PH in mesh vs no mesh cases, with a pooled OR of 0.17 [0.09; 0.34]. The included CCTs showed no significant difference in PH rate. Furthermore, no significant results were observed in subgroup analyses and postoperative complications rates.
Conclusion: The use of a prophylactic mesh significantly prevents the development of PH in comparison to a mesh-free operation. However, the overall quality of the reviewed trials was low and a large-scale multi-center RCT including an assessment of clinical relevance of hernia occurrences has to be performed.
Figure 1 [Fig. 1]